Development of Severe Anemia and Changes in Hemoglobin in a Cohort of HIV-Infected Ugandan Adults Receiving Zidovudine-, Stavudine-, and Tenofovir-Containing Antiretroviral Regimens

Rosalind Parkes-Ratanshi; David Katende; Jonathan Levin; Katie Wakeham; Grosskurth Heiner; Anatoli Kamali; David G. Lalloo

doi:10.1177/2325957414557264

Development of Severe Anemia and Changes in Hemoglobin in a Cohort of HIV-Infected Ugandan Adults Receiving Zidovudine-, Stavudine-, and Tenofovir-Containing Antiretroviral Regimens

¹MRC/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute (UVRI), Entebbe, Uganda
²Liverpool School of Tropical Medicine, Liverpool, United Kingdom
³University of Witwatersrand, Johannesburg, South Africa
⁴Epidemiology and Genetics Unit, University of York, York, United Kingdom
⁵London School of Tropical Medicine and Hygiene, London, United Kingdom
⁶Infectious Diseases Insitute, Kampala, Uganda

Rosalind Parkes-Ratanshi, Infectious Diseases Institute, Mulago Hospital Complex, PO Box 22418, Kampala, Uganda. Email: rratanshi{at}idi.co.ug

Abstract

Introduction: Anemia is a common problem in HIV in sub-Saharan Africa. We describe the contribution of antiretroviral therapy (ART) regimen to the incidence of anemia and changes in hemoglobin (Hb) in HIV-infected patients in Uganda.

Methods: This study was nested in a prevention of cryptococcal disease trial (CRYPTOPRO; ISCRTN7648152). Patients received 3 different backbones of nucleoside reverse transcriptase inhibitor in a nonrandomized manner.

Results: Of the 852 patients (161 on zidovudine [ZDV], 628 on stavudine [d4T], and 63 on tenofovir [TDF]; all received lamuvidine), the risk of developing grade 4 anemia was higher (adjusted hazard ratio 2.7) for those receiving ZDV than those receiving d4T. Those receivingd4T had a higher average increase in Hb than those receiving ZDV (P = .024) or TDF (P = .014).

Conclusion: In this observational study, ZDV was associated with severe anemia compared to d4T or TDF; those receiving ZDV and TDF had smaller increases in Hb after ART initiation. We encourage publication of data on cohorts using TDF from Africa.

Article Notes

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The CRYPTOPRO trial was funded by the Medical Research Council, United Kingdom.